RESECTION OF THE INTERNAL CAROTID-ARTERY AND REPLACEMENT WITH GREATERSAPHENOUS-VEIN - A SAFE PROCEDURE FOR EN-BLOC CANCER RESECTIONS WITH CAROTID INVOLVEMENT

Purpose: Many patients who have advanced cancer of the neck will have involvement of the internal carotid artery. The management of this con dition remains controversial, and a wide range of therapeutic options have been suggested including ligation, ''shaving'' the tumor off the carotid, or en bloc resection and replacement of the internal carotid artery by polytetrafluoroethylene, vein, or superficial femoral artery . We reviewed our experience with en bloc resections of the internal c arotid artery in a consecutive series of patients who had malignancies involving the internal carotid artery at a single institution from 19 89 to 1995. Methods: We used a retrospective chart review based on a l ist of 20 patients generated by the Hospital Cancer Registry and our V ascular Surgery clinical database. Results All patients had their inte rnal carotid artery removed and replaced with a greater saphenous vein while they were under general anesthesia. A resection of their cervic al malignancy was also performed. Concomitant myocutaneous flaps were rotated over the carotid bypass in six (30%) patients. Eight (40%) of the bypass grafts were nonreversed, and 12 (60%) were reversed, with a clear trend towards using nonreversed veins more recently. Shunts wer e used in 18 (90%). Eighteen of the 20 patients had some form of intra operative contamination including tracheostomies, pharyngostomies, or fistulas. Half of the patients had intraoperative radiation therapy, a nd 16 (80%) patients underwent operation for recurrent cancer. During the follow-up period two (10%) patients had strokes (one minor and one major), and one patient had a graft blowout, which was treated by lig ation without stroke. One patient had an asymptomatic occlusion of his graft. Conclusions: From these results we conclude that the use of th e greater saphenous vein to replace the internal carotid artery after en bloc resection is not attended by a high rate of infectious complic ations or graft blowout even in the presence of intraoperative tracheo pharyngeal contamination and that the greater saphenous vein is the co nduit of choice for replacing an internal carotid artery after cancer resections.